# CANVI BEHAVIORAL HEALTH PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144984873
- **Authorized official:** KRISTA BATTS (CONTRACTING MANAGER)
- **Authorized official phone:** (208) 380-4978

## Contact information

- **Practice address:** 4650 HAWTHORNE RD STE 3B, CHUBBUCK, ID 83202-2376
- **Practice address phone:** (208) 252-5621
- **Practice address fax:** (208) 648-4167
- **Mailing address:** PO BOX 2516, POCATELLO, ID 83206-2516
- **Mailing address phone:** (208) 380-4978
- **Mailing address fax:** (208) 648-4063

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/28/2021
- **Last updated:** 04/12/2024